Providing mental health care amid emergencies

"My brother and I have all the worries of this world,” says Johura Begum (center), age 12, who lost both parents and many other family members during the Myanmar military’s campaign of violence against the Rohingya ethnic minority. She received psychosocial care from MSF at a refugee camp in Bangladesh.
BANGLADESH 2018 © Robin Hammond/MSF
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This article is part of the Winter 2018 issue of Alert—2018: The Year in Photos—featuring some of the most striking images and stories from our work around the world.

Emergencies like conflict and natural disasters can inflict both visible and invisible wounds. People seek mental health care for many reasons—the loss of a family member in an earthquake, the trauma of violence suffered or witnessed, or the stress of forced displacement. MSF teams provide mental health care and psychosocial support through both individual and group sessions to help people cope with extremely difficult situations.

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Bangladesh

Mental Health: Rohingya Trauma and Resilience - Rohima Story
Ayesha Begum survived the violence in Myanmar along with her children. She still mourns the death of her husband, who was shot by soldiers and trampled by the crowd during their panicked escape from the village. “I cannot forget what happened. Every moment I think about it, and it causes me pain inside.”
Bangladesh 2018 © Robin Hammond

In Bangladesh, where hundreds of thousands of Rohingya refugees have settled after fleeing targeted violence in Myanmar, MSF psychologists work with patients who have survived horrific abuses. Teams provide care for victims of sexual violence, creating a “place of peace” for women to talk about their experiences and support each other. Mental health services are integrated into MSF’s medical facilities, enabling teams to reach patients who might not seek out psychosocial care due to lack of awareness or stigma.

Terrible living conditions in the camps in Bangladesh and limited prospects for the future also contribute to high levels of stress and domestic violence. “Many people are on edge, not just because of the recent trauma but because of the long-time trauma of witnessing horrific things [in Myanmar],” said MSF psychologist Cynthia Scott. Many patients say they have difficulty sleeping, paralyzed by the fear that someone might come into their homes and haunted by memories of attacks by Myanmar security forces.

Iraq

Eleven-year-old Rasha with Raz Babakr, a Médecins Sans Frontières (MSF) psychologist.
Eleven-year-old Rasha talks with Raz Babakr, an MSF psychologist, at a camp for displaced people in northern Iraq. Originally from Mosul, Rasha was traumatized by her experiences during the city’s occupation by IS and the battle with Iraqi forces. She is doing better with therapy. “I am like my old self—what I was before IS came.”
IRAQ 2018 © Sacha Myers/MSF

In Iraq, where years of conflict have forced millions to flee their homes, MSF teams work in camps for internally displaced people, providing counseling to help them process their experiences and cope with the difficulties of their daily realities. Though the city of Mosul was retaken from the Islamic State (IS) group in 2017, the local health system remains decimated and many people are living amid the rubble of ruined homes. They carry with them the psychological scars inflicted by years of life under IS and the fierce fighting when US-backed Iraqi forces retook the city.

Mosul’s old town experienced intense shelling, aerial bombing, and attacks with improvised explosive devices during the conflict to retake the city from IS. After the battle, thousands of people returned to ruined homes and the dangers of unexploded ordinance and booby traps.
IRAQ 2018 © Sacha Myers/MSF

Many people remain displaced elsewhere in Iraq. MSF works in six locations around the camps for internally displaced people near Mosul and Erbil, providing mental health services including both psychological and psychiatric consultations, group therapy, psychosocial counseling, and therapy for children.

The scars on 18-year-old Anoud’s face show only a fraction of the pain she has endured over the past year as her family struggles to recover from a bomb blast that killed her sister and brother and destroyed their home in Hawija, Iraq. Anoud looks after her eight-year-old sister, Bushra, who is receiving comprehensive treatment at MSF’s facility in eastern Mosul.
IRAQ 2018 © Sacha Myers/MSF
“Life has been really hard,” says Nashwan, 42, who came to MSF’s facility in eastern Mosul months after being shot in the back and leg by sniper fire. “My injury has had a negative impact on my life—my family, the way I interact with my kids. I can’t play with them. I can't work . . . I've been really depressed . . . But thankfully the hardest part has passed now that I am here.”
IRAQ 2018 © Sacha Myers/MSF

Mexico

Guerrero (Mexico): Under  siege
A patient receives care at a mobile clinic in Mexico’s Guerrero State, where communities are affected by extreme violence related to the drug trade. “People tell us, ‘it's good that you haven't forgotten us,’” says MSF psychologist Ivana Cervín Marín. “Because that's how they feel: forgotten.”
MEXICO 2018 © Juan Carlos Tomasi/MSF

In Mexico, MSF psychosocial teams care for refugees and migrants from Central America traveling the dangerous route north and for local communities trapped in places gripped by criminal violence. In Guerrero State, for example, where territory is fought over by organized criminal gangs vying to control trade, extort communities, and force recruitment, we run mobile clinics to provide both primary and mental health care in isolated communities and in the city of Acapulco.

MSF psychologists lead a group mental health session for children in a village in Guerrero State to help them cope with endemic violence. In many cases, children suffer from night terrors and display aggressive or irritable behavior.
MEXICO 2018 © Juan Carlos Tomasi/MSF

The constant threats and violence take a heavy psychological toll, especially on those living in rural regions far from care. “We treat people who have been through very traumatic experiences,” said Laura Moreno, MSF mental health activities manager. “People in Guerrero are tough, but if the fear and violence persist, the fabric of society could be torn apart. That’s why providing mental health care is so important here. The support we give helps to strengthen people’s coping mechanisms, so that they can manage their emotions in times of uncertainty and violence.”

A patient receives treatment at an MSF mobile clinic in a village in Guerrero State. Locals are informed about MSF’s visits in advance and notify neighboring communities about the arrival of doctors and psychologists in the area.
MEXICO 2018 © Juan Carlos Tomasi/MSF
Many people who come to MSF’s mobile clinic in Guerrero State have very limited access to health care, whether due to a lack of resources or the dangers of travel in the region. As well as supporting local health centers with supplies of basic medicines and routine visits, doctors are concerned about the lack of follow-up care for people with chronic diseases.
MEXICO 2018 © Juan Carlos Tomasi/MSF